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Mississippi rates for HCPCS J7503

Tacrolimus Extended Release (Envarsus Xr) Oral 0.25 Mg (Reinstated 01/01/2016) Cyclosporine Parenteral 250 Mg/5 Ml (Del 12/31/99)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.92 / $2.20 / $2.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.85 / $2.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.14 / $1.14 / $1.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.31 / $1.31 / $1.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.41 / $2.41 / $2.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.83 / $2.33